Impact of adding #handwashing and #water #disinfection promotion to oral #cholera #vaccination on diarrhoea-associated hospitalization in Dhaka, #Bangladesh: evidence from a cluster randomized control trial (Int J Infect Dis., abstract)

[Source: International Journal of Epidemiology, full page: (LINK). Abstract, edited.]

Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial

Nusrat Najnin, Karin Leder, Firdausi Qadri, Andrew Forbes, Leanne Unicomb, Peter J Winch, Pavani K Ram, Elli Leontsini, Fosiul A Nizame, Shaila Arman, Farzana Begum, Shwapon K Biswas, John D Clemens, Mohammad Ali, Alejandro Cravioto, Stephen P Luby

International Journal of Epidemiology, dyx187, https://doi.org/10.1093/ije/dyx187

Published: 02 September 2017 – Accepted: 15 August 2017

Citation: Nusrat Najnin, Karin Leder, Firdausi Qadri, Andrew Forbes, Leanne Unicomb, Peter J Winch, Pavani K Ram, Elli Leontsini, Fosiul A Nizame, Shaila Arman, Farzana Begum, Shwapon K Biswas, John D Clemens, Mohammad Ali, Alejandro Cravioto, Stephen P Luby; Impact of adding hand-washing and water disinfection promotion to oral cholera vaccination on diarrhoea-associated hospitalization in Dhaka, Bangladesh: evidence from a cluster randomized control trial, International Journal of Epidemiology, , dyx187, https://doi.org/10.1093/ije/dyx187

© 2017 Oxford University Press

 

Abstract

Background:

Information on the impact of hygiene interventions on severe outcomes is limited. As a pre-specified secondary outcome of a cluster-randomized controlled trial among >400 000 low-income residents in Dhaka, Bangladesh, we examined the impact of cholera vaccination plus a behaviour change intervention on diarrhoea-associated hospitalization.

Methods:

Ninety neighbourhood clusters were randomly allocated into three areas: cholera-vaccine-only; vaccine-plus-behaviour-change (promotion of hand-washing with soap plus drinking water chlorination); and control. Study follow-up continued for 2 years after intervention began. We calculated cluster-adjusted diarrhoea-associated hospitalization rates using data we collected from nearby hospitals, and 6-monthly census data of all trial households.

Results:

A total of 429 995 people contributed 500 700 person-years of data (average follow-up 1.13 years).Vaccine coverage was 58% at the start of analysis but continued to drop due to population migration. In the vaccine-plus-behaviour-change area, water plus soap was present at 45% of hand-washing stations; 4% of households had detectable chlorine in stored drinking water. Hospitalization rates were similar across the study areas [events/1000 person-years, 95% confidence interval (CI), cholera-vaccine-only: 9.4 (95% CI: 8.3–10.6); vaccine-plus-behaviour-change: 9.6 (95% CI: 8.3–11.1); control: 9.7 (95% CI: 8.3–11.6)]. Cholera cases accounted for 7% of total number of diarrhoea-associated hospitalizations.

Conclusions:

Neither cholera vaccination alone nor cholera vaccination combined with behaviour-change intervention efforts measurably reduced diarrhoea-associated hospitalization in this highly mobile population, during a time when cholera accounted for a small fraction of diarrhoea episodes. Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water, with minimal behavioural demands on impoverished communities, remain an important area for research.

Vaccine, hand-washing, water treatment, diarrhoea, hospitalization

Topic: cholera – chlorine – diarrhea – bangladesh – cholera vaccines – disinfection – feces – food – soap – vaccines – pathogenic organism – washing hands – behavioral change – low income – community – potable water

Issue Section: – Original Article

 

Key Messages

  • Neither cholera vaccination alone nor cholera vaccination combined with hand-washing and water treatment promotion measurably reduced diarrhoea-associated hospitalization.
  • The possible reasons for lack of impact of cholera vaccine alone on all-cause diarrhoea hospitalization were: cholera incidence was too low during the study period; and high migration rate diluted cholera vaccination coverage of the intervention areas during the period of the analysis.
  • The reason for the lack of impact of the behavioural intervention on diarrhoea-associated hospitalization may have been because of the low uptake.
  • Affordable community-level interventions that prevent infection from multiple pathogens by reliably separating faeces from the environment, food and water in impoverished communities remain an important area for research.

Keywords: Cholera; Diarrhea; Vaccines; Handwashing; Bangladesh.

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gimi69

I am an Italian blogger, active since 2005 with main focus on emerging infectious diseases such as avian influenza, SARS, antibiotics resistance, and many other global Health issues. Other fields of interest are: climate change, global warming, geological and biological sciences. My activity consists mainly in collection and analysis of news, public services updates, confronting sources and making decision about what are the 'signals' of an impending crisis (an outbreak, for example). When a signal is detected, I follow traces during the entire course of an event. I started in 2005 my blog ''A TIME'S MEMORY'', now with more than 40,000 posts and 3 millions of web interactions. Subsequently I added an Italian Language blog, then discontinued because of very low traffic and interest. I contributed for seven years to a public forum (FluTrackers.com) in the midst of the Ebola epidemic in West Africa in 2014, I left the site to continue alone my data tracking job.

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